This proposal presents a randomized controller study of at least 300 drugs abusing pregnant women entered either into a minimal intervention (treatment-as-usual) or a comprehensive, highly intensive drug treatment program with coordinated prenatal and pediatric care, and social, psychiatric, and education/vocational supports provided both to the women and in some instances to family members. The study will also include three non-equivalent drug-abuser comparison groups who give birth at Cook CountY Hospital: those who l)-received prenatal care at Chicago Board of Health clinics; 2) received no prenatal care; and 3) received prenatal care at CCH in the two-year period preceding the intervention. Another comparison group will consist of non-abusers who also received prenatal care at CCH during the study period. Other independent variables will include measures of age, ethnicity, family income, marital status, education, drug use severity and pattern, HIV status, and mental health. Dependent variables will include program utilization, efficacy in achieving abstinence or reduced drug use, improved obstetric outcome, and measures of infant health, infant development, maternal health and well-being, and quality of maternal-infant attachment. The design permits calculation of cost-effectiveness as well as efficacy. The design also permits tracking of obstetric and neonatal outcomes for refusal subjects and drop-outs. This project will be conducted at Cook County Hospital, the only public general hospital in Chicago, which currently has 10% of all births in Chicago, or 6,000 per year, anticipated to increase to 10,000 in 1990 as a result of hospital closings and mergers. Of the mothers giving birth at CCH, half received their prenatal care at CCH. At present 10% of new mothers admit to drug abuse on formal obstetric records, a number which is believed to underestimate the true prevalence of drug abuse.